Division of Pulmonary and Critical Care, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
Department of Radiation Oncology, Cancer Center, China Medical University Hospital, Taichung, Taiwan.
Thorac Cancer. 2017 Mar;8(2):118-120. doi: 10.1111/1759-7714.12405. Epub 2016 Nov 18.
Stereotactic body radiation therapy (SBRT) plays an important role in early stage non-small cell lung cancer. Tumor growth before radiotherapy planning (RTP) or during SBRT has been reported in lung cancer patients; however, little is known of growth during the period in-between (i.e. after RTP but before SBRT). An 83-year-old man referred to our hospital and diagnosed with medically inoperable non-small cell lung cancer was noted to have significant tumor progression on day 1 of cone beam computed tomography just before the planned SBRT delivery. Because of uncertainty of the underlying etiology and unfamiliarity with this phenomenon, we made a clinical decision to arrange re-simulation and revise our treatment to conventional fractionated radiotherapy (CFRT). After an initial response, distant metastases occurred eight months after CFRT. The patient received best supportive care and was under hospice care at the last follow-up (27 months after CFRT). We report a case with significant tumor growth just before planned SBRT. Optimal management in this scenario requires further investigation.
立体定向体部放射治疗（SBRT）在早期非小细胞肺癌中发挥着重要作用。有报道称，肺癌患者在放射治疗计划（RTP）前或 SBRT 期间会出现肿瘤生长；然而，对于 RTP 后至 SBRT 前这段时间内（即 RTP 后但 SBRT 前）的肿瘤生长情况知之甚少。一名 83 岁男性因患有无法手术的非小细胞肺癌而转诊至我院，在计划进行 SBRT 治疗前的第 1 天行锥形束 CT 检查时，发现肿瘤明显进展。由于病因不确定，对这种现象不熟悉，我们决定进行重新模拟，并修改治疗方案，采用常规分割放疗（CFRT）。在初始缓解后，CFRT 后 8 个月发生远处转移。患者接受最佳支持治疗，在最后一次随访（CFRT 后 27 个月）时处于临终关怀状态。我们报告了一例在计划 SBRT 前出现明显肿瘤生长的病例。这种情况下的最佳治疗方案需要进一步研究。
